Provider Demographics
NPI:1679744890
Name:GARCIA, LEA ANN (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:ANN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 RUSTIC CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-7131
Mailing Address - Country:US
Mailing Address - Phone:405-245-9520
Mailing Address - Fax:405-793-8855
Practice Address - Street 1:7200 RUSTIC CREEK RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-7131
Practice Address - Country:US
Practice Address - Phone:405-245-9520
Practice Address - Fax:405-793-8855
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036310BMedicaid
OK900522105OtherMEDICARE GROUP